Between one quarter and one half of older women develop symptoms and complications of urogenital aging that interfere with their day-to-day activities, functioning, or quality of life. Previous research on urogenital aging in women has focused almost exclusively on the role of postmenopausal estrogen deficiency in the development of tissue-specific markers of urogenital atrophy. Nevertheless, variations in serum estrogen levels or tissue markers of estrogen depletion do not adequately explain differences in the severity of women's urogenital symptoms, their impact on quality of life, or their responsiveness to treatment. There is a need for a multidimensional model of urogenital aging that takes into account how postmenopausal changes in estrogenicity interact with other important aging-related factors, such as changes in comorbid health conditions, decline in physical and mental functioning, and frailty and disability, to guide evaluation and management of urogenital aging symptoms in women. For this career development award, the candidate has incorporated multiple ancillary urogenital and geriatric measures into an observational cohort of ~2,000 ethnically-diverse, middle-aged and older women. Based on these measures, she will examine how older age, greater comorbidity, functional decline, and frailty influence the severity, quality-of-life impact, and utilization of treatments for symptoms of urogenital aging in postmenopausal women across the age spectrum. The proposed work has the potential to identify as-yet unrecognized geriatric factors that can influence urogenital function in older women and can lead to new strategies for preventing and treating urogenital aging symptoms. Additionally, this research may fundamentally shift evaluation and management of urogenital aging away from a narrow focus on estrogen repletion to a broader perspective that incorporates identification and treatment of geriatric conditions into prevention and treatment strategies for urogenital dysfunction in older women. With the support of experienced mentors in both geriatrics and women's health, the candidate will also pursue advanced training in geriatric medicine and geriatrics-based research, prospective longitudinal data collection and management techniques, and development and validation of self-report measures for use in diverse populations of older adults. Combined with the resources of the Beeson program and the rich training and collaborative environment of the University of California San Francisco, these research and training activities will allow the candidate to develop into an independent clinical investigator with an active, multidisciplinary research program focused on urogenital aging in older women, and will also position her to become a national leader of research at the interface of aging and women's health. PUBLIC HEALTH RELEVANCE: With the aging of the population, older women are increasingly turning to their health care providers for help with symptoms and problems related to urogenital aging that can affect their everyday activities, functioning, and quality of life. The proposed work has the potential to identify as-yet unrecognized geriatric factors that contribute to urogenital aging and that may lead to new strategies for preventing and treating urogenital dysfunction as women age. Through this research, the candidate will pave the way for a more gerocentric approach to urogenital aging that addresses the broad spectrum of co-morbidity and functional factors with the potential to influence urogenital health and function in older women.